Evidence map›Paper›PMID 41488373›Full record

ReviewFrontiers in transplantation2025

Immunosuppressive and antiinfectious regimens in vascular composite allograft recipients-a systematic review.

Leonard Knoedler, Tobias Niederegger, Thomas Schaschinger, Gabriel Hundeshagen, Javier Gonzalez, Samuel A Knoedler, Martin Kauke-Navarro, Jasper Iske, Curtis L Cetrulo, Maxime Jeljeli and 4 more

Abstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Frontiers in transplantation, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Review
  4. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Leonard KnoedlerDepartment of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
Tobias NiedereggerMedical Faculty, University of Heidelberg, Heidelberg, Germany.
Thomas SchaschingerMedical Faculty, University of Heidelberg, Heidelberg, Germany.
Gabriel HundeshagenDepartment of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Hospital Ludwigshafen, Ludwigshafen, Germany.
Javier GonzalezCedars-Sinai Medical Center, Los Angeles, CA, United States.
Samuel A KnoedlerDivision of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, United States.
Martin Kauke-NavarroDivision of Plastic Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, United States.
Jasper IskeDepartment of Cardiothoracic and Vascular Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
Curtis L CetruloVascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
Maxime JeljeliVascularized Composite Allotransplantation Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
Elena HofmannDepartment of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
Max HeilandDepartment of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
Steffen KoerdtDepartment of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
Alexandre G LellouchCedars-Sinai Medical Center, Los Angeles, CA, United States.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Introduction: Vascularized composite allotransplantation (VCA) has achieved significant clinical success, but lifelong immunosuppression remains essential to prevent rejection. Despite potent regimens, including tacrolimus, mycophenolate mofetil, and steroids, rejection episodes frequently occur within the first postoperative year. The side effects of immunosuppressive drugs must be carefully balanced against the risks of insufficient therapy. This review specifically aims to evaluate current immunosuppressive regimens and infection prophylaxis in VCA to identify evidence based approaches that attempt to mitigate rejection, prevent infections, and improve long-term graft survival. Methods: A systematic review was conducted across PubMed/MEDLINE, EMBASE, and Web of Science databases, adhering to PRISMA 2020 guidelines. Inclusion criteria focused on studies reporting immunosuppressive regimens, dosages, and infection prophylaxis in VCA surgery. Non-VCA, animal, feasibility studies, and non-English publications were excluded. Results: Of 1,150 screened articles, 42 met inclusion criteria. Upper extremity and facial VCAs represented 50% and 29% of cases, respectively, with traumatic amputation as the primary indication (37%). Antithymocyte globulin was the most common induction drug, while tacrolimus, mycophenolate mofetil, and steroids were predominant for maintenance therapy in 33% and 11% of cases, respectively. Infection prophylaxis was used in 31% of cases. Drug dosages varied widely, and no standardized immunosuppressive protocols were identified. Conclusion: Current immunosuppressive strategies in VCA lack standardization, leading to variability in outcomes and increased risks. Infection prophylaxis remains underutilized despite recipient vulnerability. There is a critical need for standardized and tailored guidelines to optimize immunosuppressive therapy and infection control, ensuring graft survival and improved patient outcomes.

Indexed as

antithymocyte globulingraft survivalimmunosuppressioninfection prophylaxismycophenolate mofetilsystematic reviewtacrolimusvascularized composite allotransplantation

Identifiers

PMID41488373
PMCPMC12756177

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.